MEDICARE: MRS. SHANNON SUSANNE MCBRIDE LPC/MHSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4023	TN

General Provider Information

NPI Number	:	1942792130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON SUSANNE MCBRIDE LPC/MHSP

Provider Business Mailing Address
First Line	:	8848 CEDAR SPRINGS LN STE 201
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-5416
Country	:	US
Telephone Number	:	865-212-6600
Fax Number	:	865-313-2149

Provider Business Practice Location Address
First Line	:	8848 CEDAR SPRINGS LN STE 201
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-5416
Country	:	US
Telephone Number	:	865-212-6600
Fax Number	:	865-313-2149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	06/04/2018

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